From Anxiety to Meltdown: How Individuals on the Autism Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums, and How You Can Intervene Effectively

238 Pages·2011·0.65 MB·English

by  Deborah Lipsky

From Anxiety to Meltdown
by the same author
Managing Meltdowns
Using the S.C.A.R.E.D. Calming Technique with
Children and Adults with Autism
Deborah Lipsky and Will Richards
ISBN 978 1 84310 908 2
of related interest
No Fighting, No Biting, No Screaming
How to Make Behaving Positively Possible for People
with Autism and Other Developmental Disabilities
Bo Hejlskov Elvén
ISBN 978 1 84905 126 2
Managing Family Meltdown
The Low Arousal Approach and Autism
Linda Woodcock and Andrea Page
Foreword by Andrew McDonnell
ISBN 978 1 84905 009 8
People with Autism Behaving Badly
Helping People with ASD Move On from
Behavioral and Emotional Challenges
John Clements
ISBN 978 1 84310 765 1
From Anxiety
to Meltdown
How Individuals on the Autism
Spectrum Deal with Anxiety, Experience
Meltdowns, Manifest Tantrums, and
How You Can Intervene Effectively
DEborAH LIpSky
Jessica Kingsley Publishers
London and Philadelphia
First published in 2011
by Jessica Kingsley Publishers
116 Pentonville Road
London N1 9JB, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA
www.jkp.com
Copyright © Deborah Lipsky 2011
All rights reserved. No part of this publication may be reproduced in any material
form (including photocopying or storing it in any medium by electronic means and
whether or not transiently or incidentally to some other use of this publication)
without the written permission of the copyright owner except in accordance with the
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to reproduce any part of this publication should be addressed to the publisher.
Warning: The doing of an unauthorised act in relation to a copyright work
may result in both a civil claim for damages and criminal prosecution.
Library of Congress Cataloging in Publication Data
Lipsky, Deborah.
From anxiety to meltdown-- : how individuals on the autism spectrum deal
with anxiety, experience meltdowns, manifest tantrums, and how you can
intervene effectively / Deborah Lipsky.
p. cm.
ISBN 978-1-84905-843-8 (alk. paper)
1. Autism spectrum disorders. 2. Anxiety. 3. Temper tantrums. 4. Crisis
intervention (Mental health services) I. Title.
RC553.A88L567 2011
616.85’882--dc22
2010047566
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN 978 1 84905 843 8
ISBN pdf eBook 978 0 85700 507 6
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1. Seeing the World Through Our Eyes . . 15
Is autism part of an evolutionary process? . . . . . . . . . 17
The importance of scripts . . . . . . . . . . . . . . . . . . . . . . 19
Heightened senses impact our ability to navigate
social settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Growing up undiagnosed with autism . . . . . . . . . . . . 24
“Scripting”: the golden rule in autism . . . . . . . . . . . . 26
Going off script 27; Hating spontaneity 32; Dealing
with going off script 33
2. Anxiety: Friend or Foe? . . . . . . . . . . . . . . . . 37
Neurological makeup similar to certain animal
species . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Difficulty making eye contact . . . . . . . . . . . . . . . . . . . 38
Reason 1: sensory integration 39; Reason 2: peripheral
versus central vision 41; Exercises to improve central
vision 45; Reason 3: a non aggressive gesture 45
Light touch interpreted as aversive . . . . . . . . . . . . . . 46
The fight or flight response . . . . . . . . . . . . . . . . . . . . . 47
A prehistoric carry over 48; Triggering a fight or flight
response 49; 1. The onset of the “freeze” response 49; 2. The
release of adrenaline 51; 3. Loss of cognitive awareness 52;
4. The danger of injury 53
The “freeze” response . . . . . . . . . . . . . . . . . . . . . . . . . 54
My personal experience with the freeze response 56
3. How Anxiety Impacts Our Cognitive
Abilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
The stress of navigating through the simple task of
shopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Societal inconsistencies . . . . . . . . . . . . . . . . . . . . . . . 66
A world of absolutes: a major reason for anxiety . . . . 68
What are we “feeling”? . . . . . . . . . . . . . . . . . . . . . . . . 70
problem solving from the autistic viewpoint . . . . . . . 74
The fear of unpredictability . . . . . . . . . . . . . . . . . . . . 74
Stimming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Stimming defuses rising anxiety levels 76; Stimming
done solely out of habit 79
The child who keeps badgering you with questions
they already know the answer to . . . . . . . . . . . . . . 80
Should we use medication to help reduce anxiety
levels in individuals with autism? . . . . . . . . . . . . . . 81
4. Rituals and Routines: A Natural
Defense for Anxiety . . . . . . . . . . . . . . . . . . . . . 85
The need for predictability . . . . . . . . . . . . . . . . . . . . . 87
Although every individual is different, routines are
universal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
What is the function of a ritual? . . . . . . . . . . . . . . . . . 89
How a ritual differs from a routine 89; Common sense,
OCD, or a ritual? 90; Unexplainable rituals 93; Minor
changes that could create anxiety, leading to new rituals
at home or school 93
Interrupting routines . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Non functional routines established unintentionally 95;
Avoiding the use of immediate tangible rewards 96;
Modify a routine gradually 97; Replacing a non
functional routine 98; Handling interruptions in
routines 100; Unforeseen interruptions in a routine 100
The influence of stress on routines and rituals . . . . 102
A personal example of how a non functional routine was
calming 103
Never interfere with a ritual or routine . . . . . . . . . . 105
5. What is a Meltdown? . . . . . . . . . . . . . . . . . . 107
Not all individuals will experience meltdowns . . . . 107
Meltdowns are not tantrums . . . . . . . . . . . . . . . . . . . 108
What is a meltdown? . . . . . . . . . . . . . . . . . . . . . . . . . 109
How I developed my interest in creating meltdown
interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
What causes a meltdown? . . . . . . . . . . . . . . . . . . . . . 112
Going off script: a leading cause of meltdowns and
catastrophic reactions 113; Not receiving comprehendible
answers: another major source of meltdowns 114
Two types of meltdown/catastrophic reaction:
cognitive and sensory meltdowns . . . . . . . . . . . . . .115
Cognitive meltdowns 115; Cognitive overload and
meltdowns 116; Too much choice causing a meltdown 117;
Bolting or running away during a meltdown 119; Witnessing
self injurious behavior during a meltdown 120; Can self
injurious behaviors occur in the Asperger’s population? 121;
The physiological response of the body during a meltdown 121;
Common warning signs and behaviors indicating increasing
anxiety, leading to a meltdown 123; The “freeze” response
heralds an impending meltdown 124; Immediately after
the highly excitable part of the meltdown phase 126;
Summary: phases of a cognitive meltdown 127; Sensory
meltdowns 128; How a sensory meltdown differs from a
cognitive one 130; Accepting sensory limits 130; Summary:
sensory meltdowns 131
Cognitive and sensory meltdowns . . . . . . . . . . . . . . 132
Shut down responses: the other extreme of a meltdown
phase 132; The aftermath of a meltdown: intense feelings
of remorse, embarrassment, and shame 133
6. How Does a Tantrum Differ from a
Meltdown? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
The golden rule in meltdowns and tantrums . . . . . . 136
Tantrums are a choice . . . . . . . . . . . . . . . . . . . . . . . . 140
Distinguishing a meltdown from a tantrum: a
checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Controlling established tantrums . . . . . . . . . . . . . . . 142
How to handle a tantrum . . . . . . . . . . . . . . . . . . . . . 143
A word of caution 145; Aggressive or self injurious
behavior during a tantrum 146; Intervening
successfully 148; How to test for a tantrum in the verbal
individual 149; How to test for a tantrum in the non
verbal individual 150; Utilizing special interests and/or
objects to test for a tantrum 151; Look for the tell tale
signs of anxiety 152; Non social tendencies 152; Instant
gratification as a potential source of tantrums 154; Using
a token system as an effective alternative 155
Today’s society as a saboteur of behavioral
interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Societal distractions as a sign of the times 157
A ray of hope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
7. Meltdown Triggers . . . . . . . . . . . . . . . . . . . . . .161
Novel situations: the number one meltdown trigger 161
Airports: my personal nemesis 162; Back up scripts
or contingency plans: the main strategy for novel
situations 164; “In the unlikely event of…” 165; A case in
point 165; Multiple back up or contingency plans are
beneficial 166; Communicating back up plans to the
severely autistic or non verbal population 167; Back up
plans for the verbal and high functioning population 168
Sensory issues compounding the stress of a novel
situation: a classic example . . . . . . . . . . . . . . . . . 169
Strategies to prevent a meltdown in this complicated
novel situation 171; You can’t prepare for all novel
situations 172
Transitions: another major contributor to meltdown 172
Transitioning from class to class 173; Transitioning
to a different subject 174; Substitute teachers as a
transition issue 176; Other transitions that can cause
a meltdown 177; Moving from one home to another 178;
Transitions revolving around parental status 179; Guidelines
for parental status transitions 180; First time visits to the dentist
or doctor 181
other triggers for meltdowns . . . . . . . . . . . . . . . . . . 182